Needlescopic lung biopsy for interstitial lung disease and indeterminate pulmonary nodules: a report on 65 cases

Ann Thorac Surg. 2008 Oct;86(4):1098-103. doi: 10.1016/j.athoracsur.2008.06.021.


Background: We evaluated the feasibility and accuracy of a needlescopic procedure for lung biopsies in patients with interstitial lung disease or indeterminate pulmonary nodules.

Methods: Sixty-five patients (36 women; mean age, 51.3 +/- 15.6; range, 13 to 76 years) underwent a needlescopic procedure to obtain lung biopsy specimens. Forty had indeterminate pulmonary nodules, and 25 had interstitial lung disease. A 2-mm needlescope and a 2-mm MiniSite Endo Grasp (Covidien, Norwalk, CT) were inserted at the sixth intercostal space along the middle and the posterior axillary line, respectively. Biopsy specimens were obtained using endostaplers.

Results: The average number of biopsy specimens was 1.7 +/- 0.6 (range, 1 to 4). For 9 patients, a frozen specimen was sent twice to pathology. Complete resection was continued after intraoperative pathology confirmation in 13 patients (lobectomy, 7; segmentectomy, 3; mass removal, 1; metastasectomy, 2). The volume of lung tissue was 8.7 +/- 11.8 cm3 (range, 0.15 to 55.44 cm3). The operation time was 58.7 +/- 37.5 minutes (range, 15 to 160 minutes). The final pathologic results were confirmed in all patients. No thoracoscopic procedure was converted to an open thoracotomy. Three patients (4.3%) had prolonged air leakage (> 5 days), and the chest tube remained in the pleural space for 2.3 +/- 2.4 days (range, 1 to 8 days).

Conclusions: Needlescopic operation for lung biopsies in patients with interstitial lung disease and indeterminate pulmonary nodules is a minimally invasive procedure that is safe and effective for obtaining a diagnosis in selected patients.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biopsy, Needle / methods*
  • Cohort Studies
  • Evaluation Studies as Topic
  • Female
  • Humans
  • Immunohistochemistry
  • Lung Diseases, Interstitial / pathology*
  • Lung Diseases, Interstitial / surgery
  • Lung Neoplasms / pathology*
  • Lung Neoplasms / surgery
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods
  • Neoplasm Staging
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Solitary Pulmonary Nodule / pathology*
  • Solitary Pulmonary Nodule / surgery
  • Thoracoscopy / methods*